Provider First Line Business Practice Location Address:
524 W INDIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-4721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-8188
Provider Business Practice Location Address Fax Number:
509-327-8182
Provider Enumeration Date:
06/20/2012